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Bajaj A, Khazanchi R, Weissman JP, Gosain AK. Can Preoperative Laboratory Values Predict Short-term Postoperative Complications and Health Utilization in Patients Undergoing Cranioplasty? J Craniofac Surg 2024; 35:137-142. [PMID: 37955436 DOI: 10.1097/scs.0000000000009858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/09/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Low hematocrit, low albumin, and high creatinine levels have been associated with postoperative morbidity. The present study intends to analyze the effects of preoperative laboratories on medical complications and postoperative health resource utilization in patients undergoing cranioplasty. METHODS Using data from the American College of Surgeons National Surgical Quality Improvement Program, demographic, clinical, and intraoperative characteristics were collected for each patient who had recorded albumin, hematocrit, or creatinine laboratory values within 90 days of the index cranioplasty. Outcomes analyzed were ≥1 medical complication, ≥1 wound complication, unplanned reoperation, 30-day readmission, and extended hospital stay (>30 d). Outcomes significant on bivariate analyses were evaluated using multivariate logistic regression. Significant outcomes on multivariate analyses were analyzed using receiver operating characteristic curves and Mann-Whitney U tests. RESULTS The 3 separate cohorts included 1349 patients with albumin, 2201 patients with hematocrit, and 2182 patients with creatinine levels. Upon multivariate analysis, increases in albumin and hematocrit were independently associated with decreased odds of medical complications and extended length of stay. Increases in creatinine were independently associated with increased odds of medical complications. Discriminative cutoff values were identified for albumin and hematocrit. CONCLUSIONS Preoperative laboratory values were independent predictors of medical complications and health utilization following cranioplasty in this study. Surgical teams can use these findings to optimize preoperative risk stratification.
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Affiliation(s)
- Anitesh Bajaj
- Division of Plastic Surgery, Lurie Children's Hospital of the Northwestern University Feinberg School of Medicine, Chicago, IL
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2
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Stein MJ, Weissman JP, Harrast J, Rubin JP, Gosain AK, Matarasso A. Clinical Practice Patterns in Abdominoplasty: 16-Year Analysis of Continuous Certification Data from the American Board of Plastic Surgery. Plast Reconstr Surg 2024; 153:66-74. [PMID: 37010463 DOI: 10.1097/prs.0000000000010500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
BACKGROUND The authors evaluated trends in practice patterns for abdominoplasty based on a 16-year review of tracer data collected by the American Board of Plastic Surgery as part of the continuous certification process. METHODS To facilitate comparison of an equal number of patients over time, tracer data from 2005 to 2021 were split into an early cohort (EC) (from 2005 to 2014) and a recent cohort (RC) (from 2015 to 2021). Fisher exact tests and two-sample t tests were used to compare patient demographics, surgical techniques, and complication rates. RESULTS Data from 8990 abdominoplasties (EC, n = 4740; RC, n = 4250) were analyzed. RC abdominoplasties report a lower rate of complications (RC, 19%; EC, 22%; P < 0.001) and a lower rate of revision surgery (RC 8%; EC, 10%; P < 0.001). This has occurred despite the increased use of abdominal flap liposuction (RC, 25%; EC, 18%; P < 0.001). There has been a decline in the use of wide undermining (81% versus 75%; P < 0.001), vertical plication of the abdomen (89% versus 86%; P < 0.001), and surgical drains (93% versus 89%; P < 0.001). Abdominoplasty surgery is increasingly performed in an outpatient setting, with increased use of chemoprophylaxis for thrombosis prevention. CONCLUSIONS Analysis of these American Board of Plastic Surgery tracer data highlights important trends in clinical practice over the past 16 years. Abdominoplasty continues to be a safe and effective procedure with similar complication and revision rates over the 16-year period.
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Affiliation(s)
- Michael J Stein
- From the Department of Plastic and Reconstructive Surgery, Lenox Hill Hospital
| | - Joshua P Weissman
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg, School of Medicine
| | | | - J Peter Rubin
- Department of Plastic Surgery, University of Pittsburgh
| | - Arun K Gosain
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg, School of Medicine
- Division of Plastic Surgery, Ann and Robert H. Lurie Children's Hospital
| | - Alan Matarasso
- From the Department of Plastic and Reconstructive Surgery, Lenox Hill Hospital
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3
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Gutowski KS, Chwa ES, Weissman JP, Garg SP, Simmons CJ, Brandt KE, Gosain AK. Practice Profile of Practicing Plastic Surgeons: A 20-year Review of Plastic Surgery Statistics. Plast Reconstr Surg Glob Open 2023; 11:e5486. [PMID: 38145152 PMCID: PMC10745238 DOI: 10.1097/gox.0000000000005486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/24/2023] [Indexed: 12/26/2023]
Abstract
Background Evaluation of practice patterns by American Board of Plastic Surgery (ABPS) diplomates allows for a greater understanding as to how the field is progressing. Understanding evolving procedural trends can give insight into plastic surgeons' subspecialty focus and influence resident training to prepare them for future practice. Methods American Society of Plastic Surgeons member only projections for aesthetic and reconstructive procedures were reviewed from 1999 to 2018 in 5-year increments to identify shifts in frequency between the beginning (1999-2003) and end (2014-2018) of the timeframe. Tracer utilization for all four ABPS modules were also examined between 2014 and 2018. Descriptive statistics were performed to identify significant changes (P < 0.05) in subspecialty focus and procedure trends. Results Annual procedure incidence between 2014 and 2018 was compared with that between 1999 and 2003. The annual number of procedures more than doubled from 3,244,084 to 6,628,082. Among reconstructive procedures, there was a statistically significant increase in the number of breast reconstruction, breast implant removal, and maxillofacial surgery procedures, and a statistically significant decrease in the number of procedures focused on reconstruction of birth defects, burn injuries, and hand anomalies. In aesthetic surgery, significant increases were seen in the number of augmentation mammoplasty, abdominoplasty, and mastopexy procedures, with significant decreases in the number of blepharoplasty and rhinoplasty procedures. Conclusions Understanding the changing practice patterns of ABPS diplomates is essential to define the direction that our specialty is taking over time, and to guide program directors in plastic surgery on areas of focus for appropriate training of plastic surgeons.
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Affiliation(s)
- Kristof S. Gutowski
- From Division of Plastic Surgery, Ann & Robert H. Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill
- Kansas City University College of Osteopathic Medicine, Kansas City, Mo
| | - Emily S. Chwa
- From Division of Plastic Surgery, Ann & Robert H. Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Joshua P. Weissman
- From Division of Plastic Surgery, Ann & Robert H. Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Stuti P. Garg
- From Division of Plastic Surgery, Ann & Robert H. Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | | | | | - Arun K. Gosain
- From Division of Plastic Surgery, Ann & Robert H. Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill
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Wan R, Weissman JP, Williams T, Ullrich PJ, Joshi C, Huffman K, Galiano RD. Prospective Clinical Trial Evaluating the Outcomes Associated with the Use of Fresh Frozen Allograft Cartilage in Rhinoplasty. Plast Reconstr Surg Glob Open 2023; 11:e5315. [PMID: 37799442 PMCID: PMC10550040 DOI: 10.1097/gox.0000000000005315] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 08/16/2023] [Indexed: 10/07/2023]
Abstract
Background There are different types of grafts for rhinoplasty, each with certain advantages and disadvantages. Fresh frozen cadaveric costal allograft (CCA) provides an alternative to rhinoplasties. The aim of this study was to compare the outcomes of fresh frozen CCA and traditional autologous costal cartilage in cosmetic and reconstructive rhinoplasty procedures. Methods This is a prospective, single-center, nonrandomized, open-label clinical trial. Objective assessment to evaluate warping, resorption, and displacement of the cartilage was achieved by measuring the differences of standardized values (deviation angle, nasofrontal angle, total facial convexity, nasofacial angle, and nasolabial angle) obtained at 6-months and 12-months postoperative follow-up on standard two-dimensional photographs (Δ = ∣measurement6 - measurement12∣). Subjective assessment was measured by the FACE-Q assessment. Results Fifty eligible patients between March 2017 and October 2020 were included. The average age was 43.9 ± 16.6 years and the mean follow-up period was 14.8 months. In the control group, the changes (Δ) in the deviation angle and nasolabial angle were greater than in the CCA group (P < 0.05). In the CCA group, the mean score of satisfaction with nose improved at 6 months and 1 year postoperatively (P < 0.05). The mean score of satisfaction with nostrils and overall facial appearance also increased in the CCA group at 6 months postoperatively (P < 0.05). Six patients from the CCA group and 10 patients from the control group experienced postoperative complications. Conclusions Fresh frozen CCA is a safe and reliable source of rhinoplasty grafts. It is aseptic, readily available, and free of donor site complications.
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Affiliation(s)
- Rou Wan
- From the Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minn
| | - Joshua P. Weissman
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Tokoya Williams
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Peter J. Ullrich
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Chitang Joshi
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Kristin Huffman
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Robert D. Galiano
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
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5
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Garg SP, Weissman JP, Chwa ES, Galiano RD. Content Validity of a Novel Scar Assessment Tool Evaluating the Career and Sexual Well-being Impact of Scars. Plast Reconstr Surg Glob Open 2023; 11:e5118. [PMID: 37448762 PMCID: PMC10337705 DOI: 10.1097/gox.0000000000005118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 05/30/2023] [Indexed: 07/15/2023]
Abstract
Currently, patient reported outcome scales used to assess scar impact focus solely on psychosocial well-being, symptoms, and appearance. There remains a need to develop a broadened measure of scar impact on patients, focusing on sexual and career aspects. This study investigates the content validity of the novel Career and Sexual Well-being (CS) Scar Impact Scale. Method The CS scale contains five questions and was developed from previous patient thematic analysis interviews describing scar impact, and covers self-conscious behavior, new partners, hiding of the scar, being hindered in the workplace, and concerns regarding unprofessional appearance. Cognitive interviews and established guidelines were used to ensure that the scale was comprehensive, reproducible, and easily understandable. Results In total, 86 patients completed cognitive interviews. Patients had a clear understanding of the questions and elicited their intent in the interviews. An estimated 86% of patients rated the CS scale coverage of scar impact on career and sexual health at a three or above out of four; 95% said the specific instructions were clear, and 92% stated it took them less than 4 minutes to complete the scale. After the first round of interviews, a question about "perception/self-consciousness in a professional environment" was added based on patient suggestions. Conclusions The CS scar scale demonstrated face validity, acceptability, and field-readiness through cognitive interviewing of patients at our institution. Sexual well-being and career performance are important yet often neglected themes with which scars should be assessed. Usage of these tools would serve to improve current scar scales.
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Affiliation(s)
- Stuti P. Garg
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
| | - Joshua P. Weissman
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
| | - Emily S. Chwa
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
| | - Robert D. Galiano
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
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6
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Wan R, Weissman JP, Ullrich PJ, Joshi C, Williams T, Galiano RD. The Utilization of Fresh Frozen Cartilage in Asian Rhinoplasty: A New Approach. Plast Reconstr Surg Glob Open 2023; 11:e4903. [PMID: 37124386 PMCID: PMC10132705 DOI: 10.1097/gox.0000000000004903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 02/02/2023] [Indexed: 05/02/2023]
Abstract
Asian rhinoplasty generally requires augmentation procedures rather than reduction. Alloplastic grafts are fraught with higher complication rates. Autologous cartilage grafts are safer. However, Asian patients typically do not have adequate septal cartilages, and other autologous cartilage grafts may cause surgical site morbidities, prolonged surgical time, and complications, including warping and infection. Asian rhinoplasties were performed using fresh frozen cartilage by the senior author. Patients' demographics and medical histories were recorded. Anthropometric measurements (nasofrontal angle, nasofacial angle, nasolabial angle, and Goode ratio) were taken on two-dimensional photographs. FACE-Q scales were used to assess patient-reported outcomes. Five Asian patients underwent rhinoplasty using the fresh frozen cartilage and were followed up for an average period of 14.2 ± 3.35 months. There was no resorption, warping, or infection. Anthropometric measurements showed no significant changes 2-4 months or 8-20 months after surgery. At the time of the 1-year follow-up, mean FACE-Q Satisfaction with Nose, and Satisfaction with Nostrils scores improved from 35.2 ± 10.06 to 60 ± 15.48 (P = 0.0002), and 42.6 ± 20.31 to 59.8 ± 38.21 (P = 0.12), respectively. Fresh frozen cadaveric cartilage is a novel option for Asian rhinoplasty. Our study demonstrated its safety and satisfying surgical outcomes.
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Affiliation(s)
- Rou Wan
- From the Division of Plastic and Reconstructive Surgery, Mayo Clinic Rochester, Rochester, Minn
| | - Joshua P. Weissman
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine , Chicago, Ill
| | - Peter J. Ullrich
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine , Chicago, Ill
| | - Chitang Joshi
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine , Chicago, Ill
| | - Tokoya Williams
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine , Chicago, Ill
| | - Robert D. Galiano
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine , Chicago, Ill
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7
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Weissman JP, Reddy NK, Shah ND, Gosain AK. Global Cleft Lip and Palate Outreach: A Google Trends Analysis. Cleft Palate Craniofac J 2023; 60:474-481. [PMID: 34930059 DOI: 10.1177/10556656211069823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Understanding patient awareness of cleft lip and/or palate (CL/P) and evaluating demand for necessary procedures may serve to better target future efforts in global outreach. We utilized internet search query data from Google Trends for the terms: "cleft lip," "cleft palate," "cleft lip and palate," "cleft surgery," and "cleft repair" from January 2004 to January 2021. Relative search volumes (RSV) recorded for the top 5 highest displaying countries and top 3 available regions within those countries were compared against global outreach by Operation Smile and Smile Train, as measured by the number of patients treated. World Health Organization (WHO) indicators were used to validate the RSV values for each country and better understand the current infrastructure and need for cleft care in those countries. Globally, there was an increase in RSV for the terms "cleft lip," "cleft palate," "cleft repair," and "cleft surgery" between 2004 and 2021. For "cleft lip," the countries with the highest displaying RSVs included: Ghana (100%), Zimbabwe (97%), Nepal (78%), the Philippines (64%), and Kenya (52%). Countries with high RSVs and moderate to high WHO indicators included Ghana, Kenya, India, Nigeria, and Zimbabwe. Countries with high RSVs and poor WHO indicators included Nepal and Pakistan. Some countries had specific regions with high search demand that are not currently targeted for global outreach. Using Google Trends' data may help find more feasible locations and targeted care for efforts in global outreach with better patient awareness and turnout where demand for CL/P is increasing.
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Affiliation(s)
- Joshua P Weissman
- Division of Plastic and Reconstructive Surgery, 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Narainsai K Reddy
- Division of Plastic Surgery, 2429Lurie Children's Hospital, Chicago, IL, USA
| | - Nikhil D Shah
- Division of Plastic and Reconstructive Surgery, 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Arun K Gosain
- Division of Plastic and Reconstructive Surgery, 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Plastic Surgery, 2429Lurie Children's Hospital, Chicago, IL, USA
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8
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Reddy NK, Shah ND, Weissman JP, Chwa ES, Gosain AK. Evaluation of Global Cleft Care Initiatives Among the Top Searched Low- and Middle-Income Countries. Cleft Palate Craniofac J 2023:10556656231160399. [PMID: 36866656 DOI: 10.1177/10556656231160399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
OBJECTIVE International outreach for cleft lip and/or palate care has traditionally been characterized by foreign groups and individuals holding surgical outreach trips in low- and middle-income countries. However, this "magic bullet" approach has often been criticized for prioritizing short-term results that may disrupt local workflow. The presence and impact of local organizations that support cleft care and take on capacity building initiatives has not been well explored. DESIGN Eight countries previously studied as having the highest Google search demand for CL/P were chosen for the scope of the study. Local NGOs in regions were identified through a web search, and information was collected regarding the location, objectives, partnerships, and work conducted thus far. RESULTS Countries with a strong combination of local and international organizations included Ghana, Philippines, Nepal, Kenya, Pakistan, India, and Nigeria. The country with minimal to no local NGO presence included Zimbabwe. Local NGOs often supported education and research, training of providers and staff, spreading community awareness, offering interdisciplinary care, and opening cleft clinics and hospitals. Unique initiatives included starting the first school for children with CL/P, enrolling patients in the national healthcare to cover CL/P care, and monitoring the referral system to improve efficiencies in the healthcare system. CONCLUSIONS Moving towards a mindset of capacity building not only involves bilateral partnerships between international host sites and visiting organizations, but also collaboration with local NGOs that have a deep understanding of local communities. Successful partnerships may help address the complex challenges regarding CL/P care faced by LMICs.
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Affiliation(s)
- Narainsai K Reddy
- Texas A&M School of Medicine, Engineering Medicine (EnMed), Houston, Texas, USA
- Division of Plastic Surgery, Lurie Children's Hospital, Chicago, IL, USA
| | - Nikhil D Shah
- Division of Plastic Surgery, Lurie Children's Hospital, Chicago, IL, USA
| | - Joshua P Weissman
- Division of Plastic Surgery, Lurie Children's Hospital, Chicago, IL, USA
| | - Emily S Chwa
- Division of Plastic Surgery, Lurie Children's Hospital, Chicago, IL, USA
| | - Arun K Gosain
- Division of Plastic Surgery, Lurie Children's Hospital, Chicago, IL, USA
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9
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Chwa ES, Weissman JP, Applebaum SA, Gosain AK. The financial implications of telemedicine practice patterns across pediatric surgical specialties. J Pediatr Surg 2022; 57:860-864. [PMID: 35649744 PMCID: PMC9077903 DOI: 10.1016/j.jpedsurg.2022.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/14/2022] [Accepted: 04/29/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Telemedicine has played an increasingly important role in surgical care during the coronavirus disease 2019 (COVID-19) pandemic, yet little is known about its usage and correlation to cost both within and across surgical specialties during the pandemic. STUDY DESIGN We collected data on telehealth encounters from April 2020 to June 2021 for all surgical specialties at a pediatric academic institution. The percent of total encounters that were telemedicine vs. in-person were analyzed over time. Data on charge and reimbursement were averaged for each encounter type, and the percent difference in average charge and reimbursement was calculated and compared between surgical specialties. RESULTS Of the 147,007 surgical clinical visits identified, 6,566 encounters (4.5%) were telemedicine. Usage peaked in April and plateaued in June of 2020. The specialties with the highest total percentages of telemedicine visits were neurosurgery (23.2%) and cardiovascular-thoracic (11.9%). Orthopedics reported the lowest usage at 2%. Charges for in-person encounters were higher for nearly all specialties while reimbursements remained equal. CONCLUSION Our institutional trends reveal that conversion to telemedicine varied across surgical specialty during the COVID-19 pandemic. Charges for in-person encounters were higher than telehealth ones for nearly all specialties, but the reimbursements were fairly the same. Understanding trends in telemedicine volume instigated by and following the pandemic may better prepare pediatric institutions to navigate the accelerated adoption and influence policy changes. This is particularly relevant given the fluctuating impact of the pandemic on healthcare institutions as new strains of COVID-19 emerge. EVIDENCE LEVEL Level V.
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Affiliation(s)
- Emily S. Chwa
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Joshua P. Weissman
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sarah A. Applebaum
- Division of Pediatric Plastic and Reconstructive Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Box 93, Chicago, IL 60611, United States
| | - Arun K. Gosain
- Division of Pediatric Plastic and Reconstructive Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Box 93, Chicago, IL 60611, United States,Corresponding author
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Merrick E, Weissman JP, Patel SJ. Utilizing Google trends to monitor coronavirus vaccine interest and hesitancies. Vaccine 2022; 40:4057-4063. [PMID: 35660035 PMCID: PMC9149202 DOI: 10.1016/j.vaccine.2022.05.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 11/24/2022]
Abstract
Introduction Vaccine hesitancy remains a serious challenge for ending the coronavirus disease 2019 (COVID-19) pandemic. Digital media has played an immense role in the spread of information during the pandemic. One method to gauge public interest in COVID-19 related information is to examine patterns of online search queries. Methods Google Trends (GT) was used to analyze results for search terms relating to COVID-19 vaccine misinformation, information, and accessibility from October 1st, 2020 to May 27th, 2021. GT allows you to compare multiple queries at one time. The resultant relative search volumes (RSVs) range from 0 to 100. The search term and point in time on the graph that has the greatest search volume is given a score of 100 and all other terms and times are given values relative to that maximum. Search interest peaks were analyzed by subgroups (misinformation, information seeking, and access seeking) and across key time points throughout the pandemic. Results GT analysis revealed that search interest related to vaccine misinformation, general information, and access seeking changed in relation to events taking place throughout the pandemic. The most commonly searched terms in each subgroup were: “Covid vaccine infertility”, “Covid vaccine side effects”, and “Covid vaccine appointment”. Searches related to misinformation peaked in December 2020. Search terms in the general information category peaked in April 2021. RSVs for access seeking terms peaked in March 2021 and have decreased since April 2021. Conclusion Misinformation RSVs were highest after FDA authorization and have multiple repeated spikes after subsequent vaccine announcements. General information seeking terms peaked concurrently with increased vaccination uptake in the United States. Search interest has decreased with wider vaccine availability, despite many individuals in the United States remaining unvaccinated. GT can be used to monitor trends in public attitudes and misinformation regarding COVID-19 vaccines and further target education.
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Affiliation(s)
- Emily Merrick
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joshua P Weissman
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sameer J Patel
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Division of Infectious Diseases, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
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Merrick E, Weissman JP, Ascha M, Jordan SW, Ellis M. National Trends in Gender-Affirming Surgical Procedures: A Google Trends Analysis. Cureus 2022; 14:e25906. [PMID: 35844341 PMCID: PMC9278897 DOI: 10.7759/cureus.25906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/05/2022] Open
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Weissman JP, Bartel T. 68Ga-DOTATATE Uptake in COVID-19 Pneumonia: A Non-Neoplastic False Positive. World J Nucl Med 2022; 21:163-165. [PMID: 35865152 PMCID: PMC9296249 DOI: 10.1055/s-0042-1750341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In the detection and characterization of neuroendocrine tumors (NETs), the NETSPOT
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Ga-DOTATATE positron emission tomography/computed tomography (PET/CT) utilizes a somatostatin analog to capture whole body imaging of somatostatin receptors. Here, we report a rare case of incidental coronavirus disease 2019 (COVID-19) detection using
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Ga-DOTATATE PET/CT for a 48-year-old patient with COVID-19 who presented to our nuclear medicine department for oncologic and neuroendocrine indications. Current maximal intensity project image from 68Ga-DOTATATE PET/CT demonstrated numerous hypermetabolic foci in the upper abdominal lymph nodes, consistent with somatostatin-avid pancreatic islet cell neoplasm. Radiotracer uptake corresponding to the anatomic infiltrates was also seen in the bilateral pneumonia. With the rise of worldwide COVID-19 cases, and the continued use of NETSPOT for somatostatin avid neoplasms, it is imperative that diagnostic measures of this disease are clearly understood. This case highlights the importance of including COVID-19 on the differential diagnosis when radiotracer uptake appears in
68
Ga-DOTATATE PET/CT.
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Affiliation(s)
- Joshua P. Weissman
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Twyla Bartel
- Global Advanced Imaging, PLLC, Little Rock, Arkansas, United States
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Yu SY, Ullrich PJ, Weissman JP, Joshi CJ, Taylor R, Patel A, El Hoseny S, Galiano RD. Evaluation of Altrazeal transforming powder dressing on stage 2-4 pressure ulcers: a clinical case series. J Wound Care 2022; 31:S6-S12. [PMID: 35576198 DOI: 10.12968/jowc.2022.31.sup5.s6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Pressure ulcers (PUs) are hard-to-heal, open wounds that affect millions of adults worldwide. Patients experience physical, mental, social and financial impairment. On average, <50% of stage 3 and 4 PUs heal by the sixth month. Treatment of PUs is highly variable due to a patient's comorbidities, demographics and wound characteristics. Because of this, there exists no standard dressing for PUs. Altrazeal transforming powder dressing (TPD, Uluru Inc., US) offers a promising new form of wound treatment; however, little evidence exists for TPD in the treatment of hard-to-heal PUs. This case series sought to examine the effect of TPD in hard-to-heal PUs that have previously undergone unsuccessful standard of care (SoC) wound therapy. METHODS This case series used retrospective data from patients with stage 2-4 PUs that failed to heal after SoC therapies. Factors examined were: number of dressing changes; time between dressing changes; time to wound closure; and pain level. While data were assessed for all patients, we focused on the six particular cases that most clearly illustrated the effect of TPD on wound healing. RESULTS Each of the 21 patients treated with TPD experienced successful and expedited wound closure. Stage 4 PUs took an average of 87 days with approximately six dressing changes to closure. Stage 3 PUs took an average of 41 days with approximately four dressing changes, and stage 2 PUs an average of 13 days to closure with approximately one dressing change. In the cases presented herein for which pain scores were reported, each showed a reduction in pain from an 8 or 9/10 to a 1 or 2/10 with the first dressing change. CONCLUSION In this case series, TPD effectively reduced pain and healed PUs that had previously failed SoC interventions. We suggest future prospective studies in order to more effectively measure the wound healing capability and healthcare utilisation of TPD for treatment of PUs.
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Affiliation(s)
- Shin Young Yu
- Chicago Medical School, Rosalind Franklin University, North Chicago, IL, US
| | - Peter J Ullrich
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, US
| | - Joshua P Weissman
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, US
| | - Chitang J Joshi
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, US
| | - Reagan Taylor
- General Surgery, AdventHealth Medical Group, Orlando, FL, US
| | - Anooj Patel
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, US
| | | | - Robert D Galiano
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, US
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Weissman JP, Stein MJ, Harrast J, Rubin JP, Matarasso A, Gosain AK. 61. EVOLVING CLINICAL PRACTICE PATTERNS IN ABDOMINOPLASTY: A 16-YEAR ANALYSIS OF CONTINUOUS CERTIFICATION TRACER DATA FROM THE AMERICAN BOARD OF PLASTIC SURGERY. Plast Reconstr Surg Glob Open 2022. [PMCID: PMC8984454 DOI: 10.1097/01.gox.0000828232.96327.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Weissman JP, Plantz MA, Gerlach EB, Cantrell CK, Butler B. 30-Day outcomes analysis of surgical management of radial head fractures comparing radial head arthroplasty to open reduction internal fixation. J Orthop 2022; 30:36-40. [PMID: 35241885 PMCID: PMC8857409 DOI: 10.1016/j.jor.2022.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 02/07/2022] [Accepted: 02/11/2022] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Radial head arthroplasty and open reduction internal fixation are two commonly utilized treatment options for radial head fractures. The purpose of this study is to assess the incidence of and risk factors for short-term complications following radial head arthroplasty and open reduction internal fixation of radial head fractures. METHODS The American College of Surgeons National Surgical Quality Improvement Program was queried to identify patients that underwent radial head arthroplasty or open reduction internal fixation for radial head fractures between January 1st, 2015 and December 31st, 2017. The incidence of various 30-day complications, including unplanned readmission, reoperation, non-home discharge, mortality, surgical/medical complications, and extended length-of-stay were compared between the two propensity matched groups. Multivariate logistic regression was used to identify independent risk factors for various short-term complications. RESULTS After propensity matching, a total of 435 patients were included in our analysis. 250 patients underwent radial head arthroplasty, and 185 patients underwent open reduction internal fixation. Arthroplasty treated patients had a significantly longer mean total operative time (p = .031) and length-of-stay (p = .003). No significant 30-day complications differences were found for unplanned readmission, reoperation, non-home discharge, mortality, surgical complications or medical complications. Independent risk factors for any complications of both procedures included a history of chronic obstructive pulmonary disease and American Society of Anesthesiologists class III. Significant risk factors for length-of-stay greater than two days included a history of bleeding disorder and American Society of Anesthesiologists class III. CONCLUSION Our study revealed there were no significant differences in 30-day perioperative surgical or medical complications from either surgical treatment of radial head fractures; however, radial head arthroplasty treated patients were met with a significantly longer length-of-stay and longer duration of operating time. We also identified risk factors that were independently associated with higher rates of complications regardless of treatment type.
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Affiliation(s)
- Joshua P. Weissman
- Corresponding author. Department of Orthopaedic Surgery, Northwestern Memorial Hospital, 676 North Saint Clair-Suite 1350, Chicago, IL, 60611.
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16
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Weissman JP, Reddy NK, Shah ND, Gosain AK. Global Cleft Lip and Palate Trips: A Google Trends Analysis. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.08.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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17
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Weissman JP, Samlowski W, Meoz R. Hedgehog Inhibitor Induction with Addition of Concurrent Superficial Radiotherapy in Patients with Locally Advanced Basal Cell Carcinoma: A Case Series. Oncologist 2021; 26:e2247-e2253. [PMID: 34472658 DOI: 10.1002/onco.13959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/19/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Locally advanced basal cell cancer is a rare and challenging clinical problem. Historically, these patients were treated with aggressive surgery or radiotherapy. Most sporadic basal cell carcinomas have somatic mutations in the hedgehog pathway. Oral hedgehog inhibitors induce rapid and often complete clinical responses in locally advanced basal cell tumors. Unfortunately, these responses are usually transient. We hypothesized that treatment failure represents persistence of drug resistant cells that could be eradicated by addition of localized radiotherapy. MATERIALS AND METHODS We performed a retrospective review of our patients with locally advanced basal cell cancer treated with sonidegib or vismodegib induction therapy who were treated with added superficial radiotherapy at the time of maximal response. RESULTS Twelve patients met inclusion criteria. All patients achieved a complete response following hedgehog inhibitor therapy with addition of radiotherapy. Progression-free survival at 40 months was 89%, with a median follow-up of 40 months. Relapses occurred in only 2 of 12 patients (16.6%). Nine patients experienced grade I-II toxicity from hedgehog inhibitor induction therapy (taste changes [3], weight loss [3], muscle cramps [3]). Eight patients experienced mild radiotherapy-induced skin toxicity during concurrent therapy. No patients had to discontinue treatment. CONCLUSION Induction therapy with hedgehog inhibitors followed by addition of concurrent radiation therapy resulted in an extremely high clinical response rate with relatively minor and reversible toxicity. This gave a high rate of progression-free survival and a low disease-specific progression rate. Further prospective evaluation of this treatment approach is needed to confirm the apparent clinical activity. IMPLICATIONS FOR PRACTICE Locally advanced basal cell cancers are challenging to treat. Previously, aggressive surgical resection or radiotherapy represented the best treatment options. Most basal cell cancers have somatic mutations in the hedgehog pathway. Oral inhibitors of this pathway produce rapid but transient clinical responses. This study reports 12 patients treated with hedgehog inhibitor induction therapy to near-maximal response. Addition of concurrent involved field radiotherapy resulted in a very high complete response rate with minimal toxicity. There was prolonged progression-free survival in 90% of patients. This study identified a novel treatment approach for patients with advanced basal cell carcinoma.
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Affiliation(s)
- Joshua P Weissman
- Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA.,Comprehensive Cancer Centers of Nevada, Las Vegas, Nevada, USA
| | - Wolfram Samlowski
- Comprehensive Cancer Centers of Nevada, Las Vegas, Nevada, USA.,School of Medicine, University of Nevada, Las Vegas, Las Vegas, Nevada, USA.,University of Nevada School of Medicine, Reno, Nevada, USA
| | - Raul Meoz
- Comprehensive Cancer Centers of Nevada, Las Vegas, Nevada, USA.,School of Medicine, University of Nevada, Las Vegas, Las Vegas, Nevada, USA.,University of Nevada School of Medicine, Reno, Nevada, USA
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Wester JR, Weissman JP, Reddy NK, Chwa ES, Gosain AK. The Current State of Cleft Care in Sub-Saharan Africa: A Narrative Review. Cleft Palate Craniofac J 2021; 59:1131-1138. [PMID: 34397305 DOI: 10.1177/10556656211038183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To identify practices and limitations of cleft care in sub-Saharan Africa (SSA). DESIGN A retrospective narrative nonsystematic literature review was performed. SETTING Literature exploring the management practices of cleft lip and/or palate across regions in SSA was included. PARTICIPANTS Full text case reports, retrospective studies, prospective studies, clinical trials, and review articles written and published in English between 1966 and February 1, 2021, were included in this analysis utilizing PubMed, MEDLINE, EMBASE, and Google scholar databases. MAIN OUTCOME MEASURES Qualitative themes identified in analysis were clinical practice patterns, current infrastructure and limitations of cleft repair, training and interdisciplinary teams, economic analyses, and international partnerships. RESULTS Significant barriers to care identified in SSA include lack of hospital resources, craniofacial training, access to multidisciplinary specialists, and public awareness. These problems make the entire care journey difficult for patients. Increasing public education has the power to diminish late presentations to hospitals. Providing adequate hospital resources and craniofacial training through international and organizational partnerships can ensure that more patients will receive care. Increasing the availability and number of multidisciplinary specialists is crucial to follow up care which aims at improving functional outcomes. CONCLUSION This narrative review highlights current practices and limitations in cleft care, emphasizing the importance of effective and timely repair of clefts in SSA. Targeted efforts aimed at establishing sustainable infrastructure for cleft care in SSA can have significant individual and community health and economic benefits.
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Affiliation(s)
- James R Wester
- 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joshua P Weissman
- 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Emily S Chwa
- 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Arun K Gosain
- 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,2429Lurie Children's Hospital, Chicago, IL, USA
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19
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Weissman JP, Goedderz C, Mutawakkil MY, Swiatek PR, Gerlach EB, Patel MS, Kadakia AR. Trends in Leadership Within Orthopedic Foot and Ankle Fellowships. Foot & Ankle Orthopaedics 2021; 6:24730114211033299. [PMID: 35097467 PMCID: PMC8702739 DOI: 10.1177/24730114211033299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: No study in the orthopedic literature has analyzed the demographic characteristics or surgical training of foot and ankle fellowship directors (FDs). Our group sought to illustrate demographic trends among foot and ankle fellowship leaders. Methods: The American Orthopaedic Foot & Ankle Society (AOFAS) Fellowship Directory for the 2021 to 2022 program year was queried in order to identify all foot and ankle fellowship leaders at programs currently offering positions in the United States and Canada. Data points gathered included age, sex, race/ethnicity, location of surgical training, time since training completion until FD appointment, length in FD role, and individual research H-index. Results: We identified 68 fellowship leaders, which consisted of 48 FDs and 19 co-FDs. Sixty-five individuals (95.6%) were male, and 3 (4.4%) were female. As regards race/ethnicity, 88.2% of the leadership was Caucasian (n = 60), 7.4% was Asian American (n = 5), 1.5% was Hispanic/Latino (n = 1), and 1.5% was African American (n = 1). The average age was 51.5 years, and the calculated mean Scopus H-index was 15.28. The mean duration from fellowship training to fellowship leader position was 11.23 years. Conclusion: Leaders within foot and ankle orthopedic surgery are characterized by research prowess and experience, but demographic diversity is lacking. Level of Evidence: Level III.
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Affiliation(s)
- Joshua P. Weissman
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Cody Goedderz
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Muhammad Y. Mutawakkil
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Peter R. Swiatek
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Erik B. Gerlach
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Milap S. Patel
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anish R. Kadakia
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Wan R, Weissman JP, Grundman K, Lang L, Grybowski DJ, Galiano RD. Diabetic wound healing: The impact of diabetes on myofibroblast activity and its potential therapeutic treatments. Wound Repair Regen 2021; 29:573-581. [PMID: 34157786 DOI: 10.1111/wrr.12954] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 12/12/2022]
Abstract
Diabetes is a systemic disease in which the body cannot regulate the amount of sugar, namely glucose, in the blood. High glucose toxicity has been implicated in the dysfunction of diabetic wound healing, following insufficient production (Type 1) or inadequate usage (Type 2) of insulin. Chronic non-healing diabetic wounds are one of the major complications of both types of diabetes, which are serious concerns for public health and can impact the life quality of patients significantly. In general, diabetic wounds are characterized by deficient chemokine production, an unusual inflammatory response, lack of angiogenesis and epithelialization, and dysfunction of fibroblasts. Increasing scientific evidence from available experimental studies on animal and cell models strongly associates impaired wound healing in diabetes with dysregulated fibroblast differentiation to myofibroblasts, interrupted myofibroblast activity, and inadequate extracellular matrix production. Myofibroblasts play an important role in tissue repair by producing and organizing extracellular matrix and subsequently promoting wound contraction. Based on these studies, hyperglycaemic conditions can interfere with cytokine signalling pathways (such as growth factor-β pathway) affecting fibroblast differentiation, alter fibroblast apoptosis, dysregulate dermal lipolysis, and enhance hypoxia damage, thus leading to damaged microenvironment for myofibroblast formation, inappropriate extracellular matrix modulation, and weakened wound contraction. In this review, we will focus on the current available studies on the impact of diabetes on fibroblast differentiation and myofibroblast function, as well as potential treatments related to the affected pathways.
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Affiliation(s)
- Rou Wan
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joshua P Weissman
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kendra Grundman
- Department of Surgery, Franciscan Health, Chicago, Illinois, USA
| | - Lin Lang
- Department of Surgery, Shanghai New Hongqiao Medical Center, Shanghai, China
| | - Damian J Grybowski
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Robert D Galiano
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Qureshi AI, Janssen RS, Karon JM, Weissman JP, Akbar MS, Safdar K, Frankel MR. Human immunodeficiency virus infection and stroke in young patients. Arch Neurol 1997; 54:1150-3. [PMID: 9311359 DOI: 10.1001/archneur.1997.00550210078016] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To determine the association between human immunodeficiency virus (HIV) infection and stroke among young persons. DESIGN Retrospective case-control study. SETTING Large, inner-city public hospital. PARTICIPANTS All patients aged 19 to 44 years with a diagnosis of stroke, whose HIV status was determined, admitted from January 1990 through June 1994. Controls matched for age and sex were selected from patients who were admitted during the same period for status asthmaticus whose HIV status was known. MAIN OUTCOME MEASURE The associations of HIV infection with all strokes and with cerebral infarction, after adjustment for other cerebrovascular risk factors, were evaluated by Mantel-Haenszel stratified analyses. The subtypes and causes of stroke in HIV-infected patients were compared with HIV-seronegative patients. RESULTS The HIV infection was associated with stroke (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.0-5.3) and cerebral infarction (OR, 3.4; 95% CI, 1.1-8.9), after adjustment for other cerebrovascular risk factors. Among patients with stroke, cerebral infarction was more frequent in HIV-infected patients than in HIV-seronegative patients (20 [80%] of 25 vs 48 [56%] of 88, P = .04). The frequency of cerebral infarctions associated with meningitis (P < .001) and protein S deficiency (P = .06) was higher in HIV-infected patients than in seronegative patients. CONCLUSIONS Our study suggests that HIV infection is associated with an increased risk of stroke, particularly cerebral infarction in young patients. This risk is probably mediated by increased susceptibility of HIV-infected patients to meningitis and protein S deficiency.
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Affiliation(s)
- A I Qureshi
- Department of Neurology, Emory University School of Medicine, Atlanta, Ga., USA
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